Lawmaker's bill would require insurers to cover autism treatments

By Josh Furlong, KSL.com |
Posted - Feb 7th, 2013 @ 6:01pm

SALT LAKE CITY — Utah is one of 18 states that does not require health insurers to cover Autism Spectrum Disorder, but a Utah lawmaker is proposing a bill that would require insurers to cover treatments.

The state of Utah has the highest autism prevalence rate in the United States (one in 47 children), according to a report released by the Centers for Disease Control. For the more than 18,000 families affected by autism in the state, the cost of treatment is something many cannot afford.

"We recognize this is a real disease and it's time to get the treatments done for these children," Shiozawa said. "Whether you think it's one in 47 or one in 77, the prevalence of the disease is such that it needs addressing."

"We know that time is of the essence," he added. "The longer we wait on therapy for these children, at this critical time in their developmental years, the harder it is to get therapy to work and the greater the chance of treatment failure and for them not having good outcomes — not being mainstream, not being able to achieve those independent functioning goals that they should have."

"The longer we wait on therapy for these children, at this critical time in their developmental years, the harder it is to get therapy to work and the greater the chance of treatment failure and for them not having good outcomes &mdash; not being mainstream, not being able to achieve those independent functioning goals that they should have."

For 3-year-old Craig Brown, the diagnosis of autism threw his parents into a world of uncertainty. Craig is thriving, however, thanks to a pilot program that provides treatments five days a week. The treatments have been a "striking" difference, according to Craig's parents, Bob and Cari Brown.

"This autism treatment gives Craig the best outcome possible," Cari Brown said. "The insurance mandate would do the same."

The bill would extend coverage to include programs like Applied Behavior Analysis, which is aimed at treating specific symptoms with positive reinforcement. Early treatment can be crucial for lasting effects, but the treatments are expensive. A one-hour treatment can cost about $75, which adds up to approximately $86,000 a year.

"The average household income in Utah is much less than that," Brown said. "So obviously, it's completely unaffordable for the average family."

Shiozawa said it's time for insurers to "recognize this is a disease that needs to be treated just like any other treatable disease, and there's a time that needs to happen, and the time is now."

Under the bill, families would be covered up to $50,000 annually for a child younger than 9 years old and $25,000 annually for a child who is at least 9 years old, but younger than 18 years old. Treatments covered would included pharmacy care, psychiatric care, psychological care and therapeutic care.

In Utah, 1 in 47 children has autism, the highest rate among 14 communities nationwide, according to a newly released study.

"In most states, the actual claims data comes out to 30 cents to 70 cents per member, per month. And 70 cents is on the high end," Shiozawa said. "This could save tens of thousands, perhaps up to $3 million in terms of the lifelong therapy of patients untreated. So, from a fiscal standpoint, this makes huge sense to treat it now versus later."

Shiozawa said he recognizes some insurance companies will raise opposition against a mandate to provide coverage for autism, but said he believes the costs are low enough to make it feasible.

"Many insurance companies are concerned about the obligation to pay and how it's going to affect them and their finances, and that's a very reasonable concern," he said. "What we're finding is state after state the actual cost per member, per month claims are remarkably low and affordable."